Are women requiring unplanned intrapartum epidural analgesia different in a low-risk population?

We studied 645 full-term low-risk women in early labour in 6 units to evaluate the effects of maternal characteristics and obstetric management in early labour on the use of epidural analgesia, and to analyse the relationship between epidural analgesia, progress of labour and mode of delivery using multiple logistic regression. Among variables present in early labour, nulliparity, ethnicity and obstetric unit were the strongest predictors of epidural analgesia requirement. In nulliparous women, obstetric unit affected use of epidural analgesia (P<0.05) and induction of labour was associated with increased use of epidural analgesia (odds ratio 3.45, 95% CI: 1.45-7.90). In multiparous women, only ethnicity was statistically significant (P<0.05). Epidural analgesia was associated with longer labours and more instrumental deliveries (odds ratio 2.93, 95%CI: 1.48-5.83). In the epidural group, however, we found a positive correlation between first stage duration and elapsed time before epidural analgesia. Furthermore, rate of cervical dilation was similar in the non epidural group throughout the first stage (mean 3.41 cm/h, 95%CI: 3.19-3.63) and in the epidural group after epidural analgesia decision (mean 3.99, 95% CI: 2.96-5.02), while the mean cervical dilatation rate before epidural analgesia was 0.88 cm/h (95% CI: 0.72-1.04). The need for epidural analgesia is, therefore, multifactorial and difficult to predict. Whereas nulliparity increases epidural analgesia requirement, data on the progress of labour before pain relief suggest that epidural analgesia is a marker of pain severity and/or labour failure rather than the cause of delayed progress in low-risk pregnancies.

c-myc oncogene copy number in squamous carcinoma of the head and neck.

PURPOSE: Altered resident cellular genetic sequences (oncogenes) may result in malignant transformation, maintenance of tumor growth, and metastatic propensity. In this pilot study, we have elected to probe c-myc oncogene in evaluating specimens from human squamous cell carcinoma. MATERIALS AND METHODS: Samples were obtained from 24 patients with squamous cell carcinoma of the head and neck. The ratio of tumor DNA values to that of control DNA was used to estimate the c-myc copy number. RESULTS: Data from material obtained from eight patients was analyzed to the point of c-myc copy number. Tumors varied from stage II through IV. Five originated in the oral cavity and three in the larynx. Analysis of primary tumors demonstrated that two of eight had increased c-myc copy numbers. Histologically positive neck specimens were encountered in five of the study patients. Three demonstrated elevated c-myc copy numbers, two of which had had increased copy number at the primary site. CONCLUSION: This study confirms that c-myc amplification can be present in squamous cell carcinoma of the head and neck. c-myc Amplification may also be present in neck metastasis. Oncogene amplification in neck metastasis may indicate an increased metastatic propensity for individual tumor cells demonstrating c-myc amplification.

Immunoperoxidase characterization of extramedullary plasmacytoma of the head and neck.

A retrospective analysis of 18 cases of extramedullary plasmacytoma (EMP) was done to characterize the type of immunoglobulin being synthesized by the neoplastic cells. The immunoperoxidase stain can be performed on previously fixed tissue and offers a means of predicting the likelihood of progression to multiple myeloma (MM). Tumors producing IgG make up the majority of cases of EMP in the literature and only 9% have progressed to MM. Smaller numbers of tumors producing other immunoglobulin classes have been studied, but it is clear that their prognosis is much more grave.